Heated Humidification or Face Mask To Prevent Upper Airway Dryness During Continuous Positive Airway Pressure Therapy

doi:10.1378/chest.117.1.142

Chest

Volume 117, Issue 1, January 2000, Pages 142-147

https://doi.org/10.1378/chest.117.1.142 Get rights and content

Study objectives

The objectives of this study were (1)to evaluate the way in which nasal continuous positive airway pressure(CPAP) therapy influences the relative humidity (rH) of inspired air;and (2) to assess the impact on rH of the addition of an integratedheated humidifier or a full face mask to the CPAP circuitry.

Design

The studies were performed in 25 patients withobstructive sleep apnea syndrome receiving long-term nasal CPAP therapyand complaining of nasal discomfort. During CPAP administration, temperature and rH were measured in the mask either during a night'ssleep for 8 patients or during a daytime study in which the effects ofmouth leaks were simulated in 17 patients fitted with either a nasalmask (with or without humidification) or a face mask alone.

Setting

University hospital sleep disorders center.

Measurements and results

Compared with the values obtainedwith CPAP alone, integrated heated humidification significantlyincreased rH during the sleep recording, both when the mouth was closed(60 ± 14% to 81 ± 14%, p < 0.01) and during mouth leaks(43 ± 12% to 64 ± 8%, p < 0.01). During the daytime study, asignificant decrease in rH was observed with CPAP alone. Compared withthe values measured during spontaneous breathing without CPAP(80 ± 2%), the mean rH was 63 ± 9% (p < 0.01) with the mouthclosed and 39 ± 9% (p < 0.01) with the mouth open. The additionof heated humidification to CPAP prevented rH changes when the mouthwas closed (82 ± 12%), but did not fully prevent the rH decreaseduring simulation of mouth leaks (63 ± 9%) compared with thecontrol period (80 ± 2%, p < 0.01). Finally, attachment of aface mask to the CPAP circuitry prevented rH changes both with themouth closed (82 ± 9%) and with the mouth open (84 ± 8%).

Conclusions

These data indicate that inhaled air drynessduring CPAP therapy can be significantly attenuated by heatedhumidification, even during mouth leaks, and can be totally preventedby using a face mask.

Section snippets

Materials and Methods

The studies were performed on 25 consecutive patients with a mean age of 56 ± 5 years and a mean body mass index of 30 ± 4 kg/m². All patients presented with moderate-to-severe OSAS with a mean apnea plus hypopnea index of 67 ± 29 events/h (range, 13 to 102 events/h). They were chronically treated with domiciliary nCPAP (33 ± 7 months). At a regular follow-up visit of their treatment, all of these patients reported nasal symptoms (chronic nasal obstruction, rhinitis, sneezing), making the daily

Equipment Verification

Systematic verification of the equipment showed that the mean rH, measured at the end of the hose, was always significantly higher with heated humidification than with CPAP alone (35 ± 4% vs 24 ± 3%, p < 0.01), with no significant variation of T (28 ± 1°C vs 28 ± 2°C).

Study 1

As illustrated in Figure 1 and summarized in Figure 2, the mean rH with nCPAP alone and with the mouth closed (60 ± 14%) during the first half of the night was significantly lower than that recorded during the second half of the

Discussion

This study confirms that nCPAP therapy causes significant dryness of inspired air in patients with OSAS. We found that the rH decrease can be significantly attenuated by heated humidification of inspired air, even during periods of mouth leak. In addition, when CPAP therapy was administered by face mask, the rH decrease was totally prevented in patients with OSAS.

It has been clearly established that airway dryness largely accounts for nasal discomfort during nCPAP therapy.9, 1012, 13, 14, 15, 16

ACKNOWLEDGMENTS

We thank Mr. Thierry Cornen and Mr. Fabien Curron for technical assistance and Ms. Yolande Dumet for her help in manuscript preparation.

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: Supported by CAPES and Taema Inc., France.

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Chest

Clinical InvestigationsSLEEP AND BREATHINGHeated Humidification or Face Mask To Prevent Upper Airway Dryness During Continuous Positive Airway Pressure Therapy

Study objectives

Design

Setting

Measurements and results

Conclusions

Section snippets

Materials and Methods

Equipment Verification

Study 1

Discussion

ACKNOWLEDGMENTS

Lancet

Chest

Chest

Chest

Chest

Chest

Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure

West J Med

Long-term compliance to continuous positive airway pressure therapy (nCPAP) set up during a split-night polysomnography

Sleep

Treatment of obstructive sleep apnea with nasal continuous positive airway pressure: patient compliance, perception of benefits, and side effects

Am Rev Respir Dis

Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea

Am Rev Respir Dis

Compliance with CPAP therapy in patients with the sleep apnea/hypopnea syndrome

Thorax

Relationship between oral breathing and nasal obstruction in patients with obstructive sleep apnea

Acta Otolaryngol

Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance

Am J Respir Crit Care Med

Clinical Investigations
SLEEP AND BREATHING
Heated Humidification or Face Mask To Prevent Upper Airway Dryness During Continuous Positive Airway Pressure Therapy